Biomedical and Traditional Chinese Medicine Views on Lower Back Pain

Why this topic is chosen

Lower back pain affects almost everyone at some point at a time.  It can be destabilising and severely affect one’s quality of life and mobility. It not only impacts one’s physical and mental well being, it also affects one’s financial and results in extensive social costs for the patients, family members and the economy as a whole. (Dawn W, et al 2018).  It is also one of the most common and costly medical conditions (Castillo Et al 2015).  According to Castillo Et al 2015, lower back pain is attributed to the lumbar to sacral spine. 

There are many factors that can cause back pain but the problem originates from lumbar to scarum.

 According to (Otis, 2007), 15% to 45% of adults suffer from lower back pain annually with more than 70% in their life.

In my clinical practice, we see patients from all walks of life with low to severe back pain resulting from slight sprain to prolapsed disc who has suffered chronic pain ranging from 6 months to 25 years.

Difference perspective from biomedicine and Traditional Chinese Medicine

From a biomedicine point of view

Prolapsed disc occurs when a disc bulge compresses against a a nerve root or spinal ligament or which will cause a lot of pain. It usually affects lumbar 5 to sacrum 1 because there are the main movement occurring in the lumbar.  Although it primary affect Lumbar 4 to Lumbar 5, it can also occasionally affect the lower cervical 6 and 7 and to the rest of the lumbar and rarely also affect the thoracic.  This usually occurs backwards or sideways with the symptoms arising from the irritation of the nerves.  After a few days, the inflammation will spread to other areas causing back pain or sciatica nerve pain.  

Prolapsed disc usually occurs sideways or backwards. This can cause the affected vertebrate to be irritated and result in inflammation. After a few days, it will spread to surrounding tissues nearby thus causing pain in the lumbar, sciatic or piriformis area or all of them. (Choice Books, 1994].

According to (Choice Books, 1994].  Prolapsed discs can result from trauma, heavy exercises, twisting and, heavy lifting.  Flexion of the trunk cause the nucleus at the anterior side to be compressed which cause the anterior space to be affected. Therefore any twisting motion carrying a heavy object in an erect position will compress the nucleus pulpous into the posterior space.  The end result will be disc bulges against the weakest area in the posterior annulus. Similarly, the other trauma can include slipping and falling on the buttock with great force usually cause around 50% of disc hernia. 

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Normally, by twenty five years old, the annulus fibrosis starts to degenerate although it can still withstand several micro traumas.  This marks the beginning of degenerative disc conditions. By middle age, the nucleus pulposus tends to dry up gradually and shrink slowly. (Choice Books, 1944,). From middle age, the nucleus in their discs will lose much of its moisture and start to shrink considerably. However, the bulge may spread out, but they are less apt to leak out of the casting. This will however result in a loss in the ability to distribute the shock and pressure. (Choice Books, 1944).

From a Traditional Chinese Medicine point of view

According to (Sherwin, 1992), Yin and Yang form the basic and fundamental beginning of all life and is a very vital principle in based in TCM short for Traditional Chinese Medicine. TCM is still widely used in treating all kind of diseases in South East Asia for over 2000 years.

In (胡 et al, 2008), lower back pain is related to the kidney qi deficiency, blood stagnation and other Bi syndrome (obstruction by pathogenic coldness or dampness) of which refers to the syndrome presented with unilateral or bilateral back governed by the kidneys

According to (Goto et al, 23014), blood stasis is not only related to circulation disorders, it can also give rise to other diseases as well. In a study using the Terasawa’s Blood Stasis Score, it was discovered that blood stasis can show hem rheological abnormalities, which can also cause back pain. 

According to (Xiong et al 2011), in a study conducted in four hospital with Yunnan university in Chinese medicine, 4 main syndromes were identified and associated with chronic lower back pain.

Firstly: Qi and or with blood stagnation with symptoms such as sharp pain, limited lumbar movements with purple coating at the tongue.

Secondly: In a study by Wang et al (2012), damp heat syndrome show a high correlation for severe pain due to inflammation in the joints.  The primary symptoms are redness at the localised area with swelling and redness:  the local area has a heavy sensation.  The secondary symptoms can include thirst or fever. The urine will be yellow in colour.  Tongue texture will be red with yellow and greasy.
Pulse will be  quick and slippery.

Thirdly: Cold Damp is more of a chronic condition.  According to Wang et al (2012),  cold-damp displayed coldness and pain with heaviness in the joint.  Secondary symptoms include constant pain which worsen at night especially during cold or rainy weather.  Tongue diagnosis will display: swollen and a pale texture with white greasy tongue coating.  Pulse will be stagnant or slow.

Fourthly: Kidney Deficiency

The key signs or symptoms of Kidney Qi Xu pattern include lumbar pain, weak knees with fatigue after any activities, painful heel, industrial deafness, premature ejaculation with fine, weak pulse in the Chi region.  A pale and enlarged tongue indicates poor promotion and filling of blood/ qi circulation.

As Kidney qi is weakened and its declining functions resulting in poor promotion of qi and blood circulation which make it harder to nourish the body resulting in lumbar pain and weak knee with tiredness.  Kidney is associated to bone health , impairment in the Kidney could lead to bone problem.  As the kidney is opened to the ears, any malfunction of kidney could relate to hearing dysfunction or industrial deafness.  Deficient Kidney qi and the uncontrolled jing chamber also lead to sexual dysfunction; the decline of Life Gate fire leads to poor consolidation of semen thus resulting in premature ejaculation. 

Discussions

In a study by Lam (2001) in Hong Kong , it was concluded that Chinese medicine work slower but eliminate the root cause compared to western medicine which clear the signs and symptoms faster.  It was also believed and known that western medicine comes with undesirable side effects such as gastrointestinal issues.

One of the problem arising from the interaction between Chinese medicine and biomedicine is the unfavourable result from these two interactions be it acupuncture or herbs or remedial techniques.

The majority of patients living in western countries consume pharmaceutical drugs, undertake western remedial treatment such as chiropractic or physiotherapy.  To complement western treatment with Chinese medicine treatment such as acupuncture, herbs, tuina or bone setting techniques, this would entail an understanding of what has been done by western doctors to avoid double work and minimise any harm

According to Wong (2005), Traditional Chinese Medicine has been around for over three thousand years, there must be some credibility in it to last that long, it is still been practised widely and gaining prominence in western countries as a alternative or complementary to western medicine.  There was discussion that with collaboration between Chinese medicine and biomedicine, there exist a need to establish a reliable clinical research on the safety of Chinese medicine to offer better cost effective and holistic treatments to patients resulting in better health.

Conclusion

There has been several sufficient clinical research and evidence of successful integration of TCM with western medicine.  I gathered that the difficulties faced would be overcoming the mental obstacle faced by people with cultural differences.  Westerners have been brought up with biomedicine and are more comfortable with biomedicine despite its risk compared to Chinese medicine unknown to them.

Based on the above evidence, it is clear that chinese medicine can play a dominant or complementary  role in assisting patient during their rehabilitation. 

The increasing popular use of TCM cannot be ignored considering a $4billion market share in alternative medicine with an annual growth of 1.4% in Australia. (http://www.ibisworld.com.au/industry/default.aspx?indid=1914).

The signed agreement between china in joint cooperation of clinical research and chinese medicine at the University of Western Sydney-UWS, aims at creating better education amongst westerners to benefit the Australian public.. (http://www.labonline.com.au/news/70993-UWS-and-Beijing-University-of-Chinese-Medicine-sign-MoU)

I would recommend patients undergoing rehabilitation to include Traditional Chinese Medicine as part of their complementary treatment to hasten their recovery so as to get back to their normal life as soon as possible.

References:

• Castillo, E. R., & Lieberman, D. E. (2015). Lower back pain. Evolution, Medicine, and Public Health, 2015(1), 2–3. http://doi.org.ezproxy.uws.edu.au/10.1093/emph/eou034
• Dawn M. W, Lee A. T, (2018), Chronic Lower Back Pain: Cognitive Behavioral Therapy With Family Therapy Interventions. page 1.
• Goto, H. Chin. J. Integr. Med. (2014) 20: 490. https://doi-org.ezproxy.uws.edu.au/10.1007/s11655-014-1882-7
• Lam, T. (2001). Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese. Journal of Epidemiology and Community Health, 55(10), 762-765.
• Lao L, Xu L, Xu S (2012) Traditional Chinese medicine. Integrative Pediatric Oncology: Springer. pp. 125–135.
• Otis, J. D. (2007). Managing chronic pain: A cognitive behavioral therapy approach. New York, NY: Oxford University Press.
• Qi-ling, Y., Tuan-mao, G., Liu, L., Fu, S., & Yin-gang, Z. (2015). Traditional chinese medicine for neck pain and low back pain: A systematic review and meta-analysis. PLoS One, 10(2) doi:http://dx.doi.org.ezproxy.uws.edu.au/10.1371/journal.pone.0117146
• Sherwin DC (1992) Traditional Chinese medicine in rehabilitation nursing practice. Rehabil Nurs 17: 253–255. pmid:1448606
• Sit, R. W. S., Wong, W., Law, S. W., & Wu, J. C. Y. (2016). Integrative western and traditional chinese medicine service model for low back pain. International Journal of Clinical Pharmacology and Therapeutics, 54(7), 539. doi:http://dx.doi.org.ezproxy.uws.edu.au/10.5414/CP202625
• Understanding back trouble: Practical advice on how to prevent, treat and cope with back trouble. (1994). In Choice. Marrickvill, NSW: Choice Books. Pg 22
• Wong, L. (2005). Chinese medicine: A critical look from the health care angle. its value, methodology of research and utilisation (Order No. 3203222). Available from British Nursing Database; ProQuest Central; ProQuest Dissertations & Theses Global. (305354012). Retrieved from https://search-proquest com.ezproxy.uws.edu.au/docview/305354012?accountid=36155
• 胡永華, 吳雪挺, 韋貴康. 中醫對脊柱相關疾 病中眩暈與腰痛的認識. 中國骨傷. 2008; 1: 7071.
• Xiong G, Virasakdi C, Geater A, Zhang Y, Li M, Lerkiatbundit S. Factor analysis on symptoms and signs of chronic low-back pain based on traditional chinese medicine theory. Journal of Alternative & Complementary Medicine. 2011;17(1):51-55. doi:10.1089/acm.2009.0559.kj
• Wang, Z., Fang, Y., Wang, Y. et al. Chin. J. Integr. Med. (2012) 18: 575. https://doi-org.ezproxy.uws.edu.au/10.1007/s11655-012-1172-1